Liver damage and alcohol: How do you know if you have symptomless cirrhosis?

CIRRHOSIS – is long-term liver damage that can eventually lead to liver failure and even increase the risk of cancer.

Liver disease is set to overtake heart disease to become the most common cause of death in working people, experts have warned.

This is because it develops without signs and symptoms.

It also occurs as a result of drinking too much alcohol and obesity, which experts said it also tough to tackle.

Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms.

Alarmingly, ARLD doesn’t usually cause any symptoms until the liver has been severely damaged – but symptoms can include feeling sick, weight loss, loss of appetite, yellowing of the eyes and skin, swelling in the ankles and tummy and vomiting blood.

Liver specialists Mark Hudson at Freeman Hospital, Newcastle upon Tyne, and Nick Sheron at Southampton General Hospital said recent guidelines are right to recommend screening high-risk patients for cirrhosis.

The experts have said technology to identify early liver disease exist and are supported by the health watchdog the National Institute for Health and Care Excellence (NICE).

NICE recommends that men and women drinking alcohol at potentially harmful levels – more than 50 and 35 units a week, respectively – be offered a test called transient elastography, to exclude cirrhosis.

This equates to about 2.25 million people in England and Wales.

The experts, writing in the BMJ said few GPs have access to the test – so screening can’t happen ‘overnight’.

However, they said the test is cost effective, as the lifetime cost of treating liver disease is between £50,000 and £120,000.

“We will need properly controlled trials, and these studies are in preparation,” they say.

“However, the burden of liver disease is such that doctors cannot simply sit in their ivory towers waiting for patients with liver disease to come and find them.”

However, some experts argue that despite recent NICE recommendations, there is not enough evidence to support a screening programme.

But other experts argue that despite recent recommendations from NICE, “insufficient evidence supports a screening programme for cirrhosis.”

Liver specialists Ian Rowe at the University of Leeds, and Gideon Hirschfield at Birmingham University’s Liver Research Centre said: “For a successful screening programme the test used must be simple, cheap, and, most importantly, accurate.”

Yet the test proposed to screen for cirrhosis has been shown to perform poorly in people suspected to have alcohol related liver disease, leading to many healthy people being incorrectly labelled as having cirrhosis and subject to further medical intervention, which comes with risk of physical and mental harm

Experts also argued the test is would require huge upfront costs and said people should manage risk factors for common liver diseases, such as alcohol consumption and obesity.

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